Dementia & Difficult Behaviors: Part 2- Responses and Solutions

Viktor Frankl once said, “Everything can be taken from a man but one thing: the last of the human freedoms- to choose one’s attitude in any given set of circumstances, to choose one’s own way.” When it comes to responding to difficult behaviors, it can be helpful to take a moment and remind ourselves as caregivers that we have the power to choose how to respond to a situation or difficult challenge. Our response will often impact ourselves just as much if not more than the situation at hand.

Responding vs. Reacting

As family members and caregivers, how we respond to a person with dementia who is exhibiting a difficult behavior really influences the outcome of the situation. According to Newton’s 3rd Law: For every action there is an equal and opposite reaction. This seems to be in effect in relational/ emotional situations as well. When a loved one exhibits a difficult behavior it can often escalate our own emotions such as fear, anxiety, anger, frustration, fatigue. A “reaction” is a personal emotional response to a situation influenced by our expectations and fears. When we respond with our emotional response we can often escalate the situation. It is important to stop, take 5 deep breathes, even remove yourselves from the situation for a moment. This allows caregivers to transition from a reaction to a “response”. A response is an intentional reaction to a situation that is purposeful and not personal.

Having a response instead of a reaction can be most difficult when the caregiver is a spouse, adult child, or close family member. Old histories and relational dynamics can be at play. As we learned in part 1 of this blog post it is important to remind yourself that difficult behaviors are a symptom of the dementia disease and not an expression of your loved one. When we see difficult behaviors as symptoms, then we realize that they have nothing to do with us and it is a little easier to not take the behaviors personally. Click here to read part 1 of understanding dementia and difficult behaviors. 

Ways to Respond

According to dementia expert and educator, Teepa Snow, there are a set of “I’m sorry” statements that can go a long way in defusing a difficult situation, especially if the individual is directing their aggression or frustration at you as a caregiver:

  • “I’m sorry that happened to you. That shouldn’t have happened.”
  • “I’m sorry; I didn’t mean to embarrass you.”
  • “I’m sorry; I know this is really hard.”

Yes/ No vs This/That

When it comes to approaching a task that needs to be done, some caregiver can dread them because they know they will trigger difficult behaviors. Common difficult activities can include:

  • bathing/ oral hygiene
  • dressing/ grooming
  • eating/ drinking
  • toileting
  • sleeping
  • physical activity/ turning in bed
  • Transitioning place or activities
  • Transporting to appointments

We tend to start off activities by asking a question like, “Dad, do you want to eat lunch now?” What is interesting is that when asked a yes/no question, 70% of people are likely to respond NO. Getting cooperation from an individual with dementia means following a new approach to activities. Orient them to a schedule/task and then provide a choice. For example, “Dad, it is time for lunch, would you like something hot or cold to drink?”

The Re-Approach

There are days when what you’re trying is just not working and the conflict is rising. As a caregiver, it is important to leave plenty of time and space around activities so you can be flexible and allow yourself the ability to take a step back and re-approach the situation later. During a conflict, focus on the person and not their difficult behavior. As a safety precaution, don’t initiate physical contact when your loved one is upset. This may be misinterpreted and physical aggression that requires a defensive response. Keep a tone of voice that is calming and mimic their emotions. For example, show concern about what they’re concerned about. Affirm and acknowledging their feelings will lay the foundation for re-engaging the activity later. Take a step back and don’t let your own emotions control your response to the situation. Allow time to pass and try again in a different way and you just may see a different result.   

Communication Tips

When words fail, it can be difficult to figure out how to communicate with loved ones even just in the day-to-day activities of caregiving. Here are a few tips that can be helpful tools for the dementia caregiver:

  • Use gestures when communicating. The meaning behind gestures is often preserved even when the meaning of language is not.
  • Match your non-verbal communication to your positive tone. This is going to be more communicative than your words themselves.
  • Don’t rush. Give plenty of time and space for activities and don’t ignore attempts at communication.
  • Don’t argue or correct misinformation or a misremembered memory. Enter their world rather countering their thoughts and ask questions to engage in what they want to talk about.
  • When deciphering a need allow them to verbally dance around the world using similar words. This is known as “circumlocution”.
  • Repeat back their words so they can hear what they have said and process it differently.
  • Simplify environment and limit background noise.
  • According to dementia educator, Teepa Snow, helpful questions to ask are: “Can you tell me more about it?” or “Can you show me what you do with it?”  

When Dementia Care is Needed

In 2012 in Washington State alone, there were 323,000 Alzheimer’s and dementia caregivers providing 368 million unpaid hours of care according to the Alzheimer’s Association. Whether it is diagnosed in mid-stages or as early-onset dementia, the progression of dementia is often slow extending over years. Family caregivers will often talk their experience of two types of deaths. There are the losses along the way as well as at the end-of-life loss. Spouses, adult children, and other family caregivers can often experience burnout from the physical and emotionally demanding tasks. They will even see an increase in their own health needs and healthcare costs as a direct result of their caregiving responsibilities. It is also common for the increasingly complex care needs to exceed the family caregiver’s capacity to properly care for their loved one. For families going through a dementia diagnosis it is crucial to have a discussion about plans for long-term care or respite care. Having a backup plan for when care becomes too complex or overwhelming for the family is a way to advocate for a high quality of life for both the individual and their family.

Memory Care

When it comes to finding quality Alzheimer’s Care or Dementia Care for your loved one, you have Sound Options. As a Geriatric Care Management firm and In-Home Care provider, we believe that aging safely at home is possible for those diagnosed with a wide variety and stages of dementias. This disease demands our creativity and customized care means providing caregivers equipped to understand and respond appropriately to difficult behaviors and unique needs of an individual with the brain disease. We are helping families plan for the future and find the memory care they need today. To find out more about our holistic elder care services, give us a call at 800.628.7649. 



Published on July 23, 2014.